Nephrectomy in Children: A Single Center Experience

Introduction: Almost two in five people will be diagnosed with cancer in their lifetime. These patients will commonly undergo surgical procedures requiring anesthesia. Recently, investigation has begun into whether different methods and agents of anesthesia effect the cancer disease process. The objective was to investigate different common anesthetic agents and current data on their possible effects on the cancer disease process relating to recurrence and metastasis. A literature search of utilizing common search engines and databases of PubMed, Cochrane, and Google Scholar was performed. There were no specific date inclusions and exclusion parameters. Studies were required to be relevant to the clinical question of how anesthetic agents effect the cancer disease process and progression.

Findings: There has been a significant amount of research into the topic of anesthetic agents and their specific effects on the cancer disease process as it relates to recurrence and metastasis. In this project specific agents investigated include morphine, fentanyl, propofol, sevoflurane, regional anesthesia, and local anesthesia. Morphine and Sevoflurane potentially have negative effects on cancer pathology whereas regional anesthesia and local anesthesia have been shown to have some positive effects on the cancer disease process. Agents such as propofol and fentanyl require more investigation.

Conclusion: There has been a significant amount of research into the topic of anesthetic agents and cancer recurrence and metastasis. There is data that shows some anesthetic agents may pose more risks than others when being utilized in a patient with a cancer diagnosis. More research is needed into this topic so providers can best care for patients undergoing cancer surgeries.

Keywords:Anesthesia; Morphine; Fentanyl; Propofol; Sevoflurane; Regional; Local; Cancer; Recurrence; Metastasis

Abbreviations:TSP-1: Thrombospondin-1; EGF: vascular endothelial growth factor; TGF-B: Tumor growth factor beta; IL-2: Interleukin-2; NSAIDs: Non-steroidal anti-inflammatory; COX-2: Cyclooxygenase-2; NF-Kb: Nuclear factor – kappa beta; PTEN: Phosphatase and tensin homolog; Nrf-2: Nuclear factor erythroid 2-related factor 2; MMP: Matrix metalloproteinase; NSCLC: Non-small cell lung cancer; MTOR: Mammalian target of rapamycin; GABAAR: Gamma aminobutyric acid A receptor; TRIM21: Tripartite motif-containing protein 21; Her-2: Human epidermal growth factor receptor 2; CCI Score: Charlson comorbidity index score; PT: Pathologic tumor stage; PN: Pathologic nodal stage; PCA: Patient-controlled analgesia